Delivery of life-critical health care requires timely access to mission-critical health care information. Health care delivery institutions the world over, whether in the public or private sectors, are faced with an uphill battle of ensuring people are protected by timely access to high quality health care at an affordable price.
Even sophisticated health care institutions in the advanced nations are plagued by lack of timely access to patient-records and related knowledge base, which are up to date and consistent across all domains such as clinical, biographic, financial etc. Empowered by a facility to accurately record and retrieve information on patient-care, medical personnel would be motivated to guarantee that a patient is receiving the best available treatment at a reasonable price. In addition to hygienically clean environment and life-style, a patient's welfare depends on availability of adequate supply of safe prescriptions, having minimal side effects.
Frequently, by a review of patient's information from the different sources referred to, diagnostic/therapeutic procedures prescribed by the medical team are often questionable or inappropriate, for the reasons noted hereunder:                Imprecise—usually doctor's notes are hand-written or scribbled. Nurses and pharmacists are very likely to misread the physician's instructions and are prone to take incorrect follow-up actions.        Contrasting—two or more physicians attending on a patient often independently prescribe medication for the same patient. If they fail to consult with each other, or when a patient's records are not available for timely reference by medical personnel before specifying the next course of treatment, this results in potentially life-threatening side effects. Even an alert nurse or pharmacist hardly ever catches such errors in a timely fashion.        Ill-timed—Some prescribed tests/procedures frequently need to be scheduled at the proper time and carried out in a specific order. Problems are often reported when the tests are not well coordinated. As a minimum, two items need to be addressed: (1) record of the required tests and procedures to be performed and their schedule and, (2) a list of equipment and services along with their availability. When the vital elements of information are in different and/or incompatible information systems, matching these lists to prescribe an appropriate treatment program is very difficult. It is conceivable that a patient could be scheduled for a test when the appropriate gear or medical personnel with relevant expertise are unavailable, leading to disastrous results depending on the severity of the patient's medical condition.        
Currently available health care information management systems are severely inadequate in their ability to inter-operate amongst different functional entities. Albeit individually they may have been fine-tuned for optimal performance, these information systems are incapable of harmoniously interacting with each other. There are islands of information-blocks with minimal communication among each other. Thus for instance, integrating the Patient Records database with the hospital's Financial department is a tedious exercise, needing several manual steps to retrieve/process the electronically stored records. Often the same data gets stored in different systems. This leads to the problem of data getting updated in one system, but not in the other, causing data inconsistency. For example, if the Human Resources Employee system is not adequately integrated with the Health-care Information System, the staff data concerning access privileges may be stored separately in the two systems. As a security leak, even former employees could log-in and retrieve confidential patient data, if the user accounts were de-activated in one system but not in the other . . . . The main rationale for this drawback is that currently there is no extensible and customizable information system that fosters development of health care information systems which support inter-operability among diverse standards-compliant modules.
Legacy health care information management systems have limited incorporation of security in terms of data integrity and long-term data retention. Re-engineering of medical information systems is quite a challenging notion for organizations in the health care industry, due to technical complexities as well as the general reluctance to change. Other observed deficiencies include challenges of scalability and redundancy, with the growth in the sheer volume of data of the order of millions of records handled by larger health care organizations.
Problem of Building Extensible Health Care Applications
There have been many approaches to develop standards pertaining to various domains of health care arena like DICOM in image communication and HL7 in health care data communication. Both of them define standards for communication between heterogeneous health care applications. But their efforts for the definition and development of a middleware operating system that could serve as a platform to meet the relevant industry standards and ease the building of an enterprise-class health care information systems have been inadequate.
On a different note, CORBA Med from Healthcare Domain Task Force (HDTF) of the Object Management Group (OMG) defines a set of object-level standards (by defining standard interfaces). While distributed objects form an effective means to achieve interoperability, this does not fully address the problem of developing an enterprise level health care application conforming to the global standards. CORBA Med defines a standard for component-based architecture but fails to provide a ready-to-use platform and also makes the task of writing CORBA Med compliant components, quite tedious. Another neutral platform framework for building health care information systems is the Riche frame work from Group Riche overlaid on top by the DHE (Distributed Health-care Environment). The Riche framework and DHE are too general and provide set of tightly coupled components, rendering the framework highly domain-centric.
A unique observation of the health care information systems across the globe is the diversity found in the workflow of health care institutions compared to other domains like BFSI (Banking, Finance, Security and Insurance). Existing applications need approximately ten times more work than the original efforts expended for tailoring it to meet the needs of global clients. A simple example depicting this scenario is the introduction of a mandatory Financial Clearance before admitting a patient or ordering of patient-services. Only a workflow oriented, rule-based middleware that is configurable at the higher level [i.e. Application layer] can address these issues.
Compared to the pace with which new technologies are being introduced minimal efforts are being devoted to link and use these technologies in the health care arena. This phenomena can be illustrated by use of the wireless technology in hospital information systems. Although the innovative wireless industry is booming with newer applications for the health care industry, very little standards are defined. The options available are often not viable in terms of their cost effectiveness and incompatibility to interface with existing frameworks. Similar is the case with Telemedicine that has immense potential but seen minimal field deployment due to lack of open standards and supporting frameworks. Vendors should be able to design applications for health care industry based on an open, extensible framework similar to the development of applications for the Windows or Linux. OS platforms.
A major drawback of the current HIS scenario is the use of individual ERP packages for many of the indispensable components of health care information systems like the inventory, payroll and human resources management. A tiered approach with a domain-neutral lower tier and domain-specific upper tier, together supporting applications at the highest tier can be a solution to the problem. For example, all the modules of the higher tier can use the services of a rule based flow control system defined in the lower tier.
What is clearly needed is a methodology/framework to build healthcare software applications that are well-integrated with each other, that provides accurate and dependable updated health care information in real-time, while being resilient to changes in business and legal requirements, adaptable and extensible with organizational needs, and provides disaster recovery. Also needed, is a system to make this possible with relative ease.